Hidradenitis Suppurativa (HS) Overview

What is Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a skin condition that causes small, painful acne-like lumps to form under the skin. Hidradenitis suppurativa is commonly found in areas where skin rubs against skin, such as the armpits, inner thighs, or near the groin, buttocks, or breasts.

Hidradenitis suppurativa is often mistaken for pimples, boils, or acne cysts. Without treatment, these lumps can become more painful, produce a foul-smelling discharge, leak blood or pus, and create scarring. Over time, tunnels known as sinus tracts can form under the skin. These tunnels can trap bacteria and sweat under the skin, leading to chronic infection and inflammation.

The pain and discharge of HS can be debilitating; the skin condition can impair the quality of life more than psoriasis and atopic dermatitis.

Symptoms

Hidradenitis suppurativa is often misdiagnosed for years. The average time to diagnose HS is 12 years after the first onset of symptoms, which may include:

Pimples or sores in the armpit
Underarm cysts or lumps
Boils, cysts, lumps, or pimples on the thigh
Sores, cysts, or pimples in the groin area

These pea-sized lumps, pimples, or cysts may persist for weeks or months. They may get larger and eventually break open, leaking pus or blood.

Causes

Hidradenitis suppurativa is more common after the onset of puberty. While the exact cause is unknown, the lumps form when hair follicles become blocked. Experts believe that there could be a connection between HS and:

Hormones
Genetic predisposition
Cigarette smoking
Excess weigh

Risk Factors

Other factors that can increase your chance of developing hidradenitis suppurativa include:

Age: occurrence is higher for those in their 20’s and 30’s
Sex: females are more likely to develop HS than men
Race: ethnicity may be a contributing factor
Health Conditions: such as obesity, severe acne, arthritis, diabetes, metabolic syndrome, and inflammatory bowel disease.

Diagnosing

Hidradenitis suppurativa is often misdiagnosed as ingrown hair, acne, or other skin conditions. A hidradenitis suppurativa specialist with experience diagnosing and treating HS will typically look for these three clinical features:

Typical lesions: abscesses, nodules (abnormal skin growths), scarring, and sinus tracts
Typical locations: armpits, groin, breast folds, inner thighs, and other areas where skin rubs against skin
Relapses: occurs two or more times in a six-month period

Hidradenitis Suppurativa Treatment

Hidradenitis suppurativa treatment can vary depending on the progression and severity of the skin condition.

Stage 1 HS (abscesses without sinus tracts and scarring): your hidradenitis suppurativa specialist may recommend lifestyle changes and pharmacological medications. Losing weight, stopping smoking, wearing loose-fitting clothing, and eating a healthy diet may help. Warm compresses, topical and/ or oral antibiotics, and antibacterial soaps may also be recommended.

Stage 2 & 3 HS (multiple recurrent abscesses with sinus tracts and scarring): your hidradenitis suppurativa specialist may also recommend additional hidradenitis suppurativa treatments, such as topical resorcinol (a chemical peeling agent), antiandrogenic hormonal treatments, or immunosuppressive treatments.

Stage 3 HS (diffuse or multiple interconnected sinus tracts and abscesses across the entire area): your hidradenitis suppurativa specialist may recommend HS excision surgery for those with stage 3 HS or for those who have partially or completely failed to respond to non-surgical treatments.

Hidradenitis suppurativa excision surgery removes lesions and scars resulting from the HS skin condition. It may also be used to remove sinus tracts – the "tunnels" that can form under skin scarring as HS progresses. The procedure is usually performed on an outpatient basis under local or general anesthesia during a period of dormancy.

Recovering from hidradenitis suppurativa surgery can take some time, as the procedure often involves the removal of a large area of skin. It can take anywhere from 4 to 6 weeks—and up to 6 months—for the skin to completely heal. For the first few weeks post-surgery, changing your dressings may be painful. You may ask a family member or friend to assist. Your wounds may be foul-smelling, and the area may be painful as it heals.

In some cases, multiple surgeries may be part of your overall hidradenitis suppurativa treatment plan. Your hidradenitis suppurativa specialist may also recommend a combination of treatment modalities, including surgery, medications, and lifestyle changes.

Our Doctors

The surgical team at the Institute for Advanced Reconstruction is renowned for its use of cutting-edge, advanced surgical techniques. Our doctors are leaders in their fields and passionate about helping you find relief from Hidradenitis suppurativa.

Physician

Hamid Abdollahi

MD, FACS

Physician

Tzvi Small

MD, FACS

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Insurance Information

The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.

If we are not an in-network provider, our friendly insurance specialists will help you find the most coverage available for your treatment.

Horizon Blue Cross Blue Shield of New Jersey
Medicare
Railroad Medicare
Aetna
Cigna
United Healthcare
Oxford (Freedom, Liberty)
MagnaCare

Patient Resources

The Institute for Advanced Reconstruction has locations all over the nation with expert surgeons ready to help you.

Visit our patient resource page for important forms and information about Graves’ disease treatments.

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Do you qualify for advanced hidradenitis suppurativa treatment?

If you have progressed to HS Stage 2 or 3, you may be eligible for long-term relief with hidradenitis suppurativa surgery. Contact us today to schedule a consultation with an HS specialist to find out.

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